Preventive orthodontics/certified fixed orthodontic courses by Indian dental academy

Introduction
Dental neglect :malocclusion is the permanent
dentition
Maintenance of arch length in the primary
dentition
Knowledge of dental and dentofacial growth and
development
Necessary steps to provide proper transition of
primary to permanent dentition without any
problems into proper functional, esthetic and
occlusal relationships helping in proper growth
and development of the jaws and face inturnwww.indiandentalacademy.com

Preventive Orthodontics :
to eliminate factors that may lead to
Malocclusion
anticipation of a developing problem and
nipping them in the bud
preserve the integrity of what appears to be
normal occlusion at a specific time
www.indiandentalacademy.com

Patients and parent education
Supervision of growth and development of
dentition and the craniofacial structures.
Treatment procedures instituted to prevent onset
of Malocclusion, which include:
Space Maintainance
Space regaining
Scheduling tooth-shedding timetable.
Habits
Caries control

Most people associate orthodontist with ‘braces’,
which is only a part of the whole picture.
An ideal orthodontic service should devote.
10% - Observation and prevention
20% - Interceptive procedures
25% - Partial corrective mechanotherapy and the
balance of full treatment.
45% - Full corrective, mechanotherapy cases

Interceptive procedures
Partial corrective mechanotherapy group
Full Mechanotherapy
Patient Dentist Rapport
Education of Parents
Necessity of Diagnostic Records
Care 0f Deciduous dentition
Caries Control

Indications of future Orthodontic
Problems:
Aberrant resorptive pattern
Eruption cycle of permanent teeth
Contingency of extraction
Second Deciduous molar region

Critical period of tooth exchange
Maintenance of Shedding and Eruption time
table
Sequence of Eruption and timing
Dental age
Maintenance of quadrant wise tooth
shedding time table

Delay in eruption
Presence of over retained deciduous teeth/roots
Supernumerary tooth
Cysts
Overhanging restoration in deciduous teeth
Fibrosis of gingiva
Ankylosis of primary teeth
Absence of permanent tooth bud.

Concept of preventive orthodontics
Reverse the process of the dentition’s
maldevelopment
Early attention:helpful in reducing the
severity
Tooth is maintained :result of action of a
series of forces

Factors which influence
development of Malocclusion
Abnormalcy of oral musculature
Presence of oral habits
Existence of Malocclusion
Stage of developing dentition
Loss of arch Length due to caries
Oral habits and prevention of malocclusion
Occlusal prematurities

Sequence of eruption and clinical
significance
According to LO and MOYERS:
Eruption in Maxillary arch - 6124537 :50% of
cases.
Mandibular arch - 6124357
Others show -6124573 - 11.9%
-6123475 - 5.9%
-6124375 - 5.5%
Mandibular arch, sequence -6123457 - 40%
Other variables are -6123745 – 8.4%
-6124537 - 5.5%

SPACE MAINTAINANCE
Maintenance of arch length during the primary,
mixed and early permanent dentition is of great
significance for the normal development of future
occlusion.
Injuries for antr teeth
Interproximal caries in primary molars
Ectopic eruption of first perm molars
Delayed eruption
Ankylosis of primary molars
Dental caries

Proper restoration of primary molar
Constant re-evaluation of the developing dentition
Space maintainer is a fixed or removable
appliance designed to preserve the space created
by the premature loss of a tooth
Sequelae to premature loss of Individual tooth
Permanent molar eruption pattern
Primary canine area
Primary Incisor area

Tulley and Cambell (1970): situations in which
space may be maintained with some advantage
Indications of Functional space maintainers
Function and oral health
Supra eruption of opposing teeth
Psychological effects on child and parent
Effects on the position of permanent teeth

Classification of space maintainers
I. According to Hitchcock:
Removable of fixed of semi fixed
With of without bands
Functional or non functional
Active or passive
Certain combinations of above.
II. According to Raymond C.Thurow:
Removable
Complete arch
- Lingual arch
- Extra oral anchorage
Individual tooth.

III According to Hinrichsen:
a. Fixed space maintainers:
Class I i. Non functional types
- Bar type
- Loop type
ii Functional type
- Pontic type
- Lingual arch type.
Class II - Cantilever type
- Distal shone
- B and E loop
b. Removable space maintainers:
Acrylic partial dentures:

i. Removable
Non functional – acrylic plate
Functional – acrylic plate with teeth
Active – acrylic plate with clasps, spring
Passive- acrylic plate with clasps.
ii. Fixed
Band and loop
Crown and loop
Band and bar
Distal shoe/eruption guidance
Lingual arch
Nance palatal arch
Transpalatal arch.
iii. Semi Fixed
Removable archwire with molar bands

Pre-requisites
Should maintain the M-D dimension of the space
created by lost tooth
Should be functional, if possible, atleast to the
extent of preventing the overeruption of the
opposing tooth.
Should be as simple and strong as possible.
Should be interfere with normal occlusal
adjustments
Must not endanger the remaining teeth by
imposing excessive stresses on them

Should not interfere with the erupting teeth
Should not interfere with normal vertical eruption of
the adjacent teeth.
Should have a simple design permitting easy
construction and placement.
Should be easily adjustable.
Construction should be such that they do not restrict
normal growth and developmental processes.
Should not interfere with such functions such as
mastication, speech or deglutition.
Must be easily cleansable and not serve as traps for
food debris etc., which might enhance Dental caries and
soft tissue pathology.
Should be durable and corrosion resistant.
Reasonable in cost.

Complete I/O radiographic examination
width of the deciduous teeth and all permanent
successors
Leeway space
relative amount of root resorption
Mixed dentition analysis
Crucial factor of Age
Question of molar Retention/Extraction
Oral Musculature and habits
Interdigitation
Anamolies of the teeth

Indications :-
space after premature loss shows signs of closing.
aid in or make the future ortho treatment less involved.
Contra indications :-
1/3rd of the root of succedaneous tooth is already
calcified
Space left is less that the space needed for the permanent
successor
Space shows no signs of closing
Would further complicated existing malocclusion.
Succidaneous tooth is absent.
Well developed occlusion and cuspal interdigitation or
over eruption of opposing tooth prevent space closing.

Removable space maintainers
Indications :
If abutment teeth cannot support a fixed appliance.
Cleft palate has to be closed with the denture
Bands cannot be adopted, it is advised to use a
removable space maintainer can be give.
Multiple loss of deciduous teeth which may require a
functional replacement in the form of either partial/
complete dentures.
Contraindications:
Lack of patients cooperation
Patients allergic to acrylic materials
Epileptic patients who have uncontrolled seizures.

Advantages:
Easy to clean and permit maintenance of proper oral hygiene
Maintains and restores the vertical dimension.
It can be worn part time allowing circulation of the blood to soft
tissues.
Functions like aesthetic/mastication/phonetics
Dental checkup for carries detection can be undertaken easily.
Stimulate eruption of permanent teeth
Band construction is not necessary
Room can be made for permanent teeth to erupt without changing
the appliance.
They prevent development of tongue Thrust habit into the
extraction space.
More than one tooth can be replace.
Being tissue-borne, they impose less stress on remaining teeth.
Easier to fabricate, less chair time.

Disadvantages:
Patient may not wear it, patient compliance in 3-6year
age group and uncooperative children is poor.
It may be lost or broken by the patient.
It may restrict lateral growth of the jaws if clasps are
incorporated
May cause irritation of the underlying soft tissues
Acrylic Partial Denture
Full dentures for children
Removable Distal shoe space maintainer

Fixed Space Maintainers
Advantages:
Do not interrupt with passive eruption of abutment teeth.
Jaw growth not hampered
Succedaneous permanent teeth are free to erupt in oral cavity
No patient co-operation required.
Disadvantages:
Elaborate instrumentation with expert skill is needed
Decalcification of tooth material under the kands
Supra eruption of opposing teeth can take place if pontics are not
used.
If pontics are used, it can interfere with Vertical eruption of
abutment tooth and may prevent eruption of replacing permanent
teeth, if patient fails to report.www.indiandentalacademy.com

BAND AND LOOP SPACE
MAINTAINER
commonest , unilateral
premature loss of single primary molar
Indications:
1. Unilateral loss of primary first molar before or after the
eruption of permanent first molars.
2. Bilateral loss of single primary molar before eruption of
permanent incisors.
3. When second primary molar is lost after the eruption of
first permanent molar.
4. Sometimes its given in cases of premature loss of
primary canines.

Bilateral single primary molar: two band and loops
two adjacent primary molars :not indicated
Advantages:
1. Effective for unilateral loss of single tooth in
buccal segments.
2. Economical
3. Construction-simple
4. Takes little chairside time, esp if preformed bands
R used.
5. Adjusts easily to accommodate the changing
dentition.

Disadvantages:
1. constant supervision
2. decalcification
3. Not prevent the continued eruption of the opposing
teeth.
4. Does not restore chenring function.
5. Limited to maintainance of single tooth space
6. if soldered joint broken cannot be repaired I/o

Design of wire loop:
.036” wire
1mm off gingival tissues
rest against adjacent tooth contact point
wide faciolingual dimension
occlusal clearance
3-4 months :check up

Modifications
1. Bonded Loop
2. Crown and loop
3. Band and Bar/Crown and Bar

Preventive orthodontics/certified fixed orthodontic courses by Indian dental academy

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Preventive orthodontics/certified fixed orthodontic courses by Indian dental academy